Avenues London (South)

Updated 12 July 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by two inspectors and four assistant inspectors.

Service and service type

This service provides care and support to people living in 22 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Notice of inspection

We gave a short period notice of the inspection so people could be asked if they consented to home visits from members of the inspection team.

Inspection activity started on 5 June 2019 and ended on 6 June 2019. We visited the office location on 5 June 2019.

What we did before the inspection

Before the inspection we reviewed information we already held about the service. This included information received in notifications from the provider. Providers are required by law to notify us of certain types of incident and event. We sought feedback from local authorities who commissioned care from the provider.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with six people who received a service and one relative. We spoke with 15 members of staff. This included the registered manager, three service managers, three assistant service manager and eight support workers. We reviewed eight care files including assessments, care plans, reviews and medicines records. We made observations in the schemes we visited. We reviewed 12 staff files including recruitment, supervision and training records. We reviewed records of complaints, incidents and safeguarding. We reviewed various meeting records, audit and quality assurance reports and other information and records relevant to the management of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 12 July 2019

About the service

Avenues London (south) provides personal care to 62 people with learning disabilities living in 22 different supported living schemes across South London and Kent. The schemes varied and included shared houses and individual flats. Some of the schemes had staff offices and were staffed 24 hours a day. Other schemes had different staffing arrangements depending on the needs of people living there.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People told us they felt safe and staff knew how to protect people from avoidable harm and abuse. People were supported to take medicines safely by trained staff. People told us they liked the staff who worked with them. There were enough staff, who were recruited safely, to meet people’s needs. People were supported to take risks, and there were robust risk assessments in place. We noted risk assessments were not always updated in a timely way when risks reduced. The provider had robust systems in place to respond to incidents and ensured lessons were learnt and shared.

People told us they were offered choices and their voice was clear in their care plans. Staff supported people to have maximum choice and control of their lives and staff supported people in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not support this practice as they included unclear and unnecessary capacity assessments and described people as lacking capacity when all the evidence suggested they had capacity in that area. We have made a recommendation about applying the Mental Capacity Act 2005.

People were supported to access healthcare services, although records were not always easy to find. Staff worked well with different organisations involved in providing care to people. People were supported to prepare their meals and eat and drink a balanced diet. Staff received the support and training they needed to perform their role.

People, their families and other professionals were involved in assessing needs, writing and reviewing care plans. People’s views about their care were clearly captured and they had regular opportunities to provide feedback with their keyworkers. Plans were not always updated when people’s preferences changed, but their support was adapted in response to their feedback. People and relatives knew how to make complaints and were confident their concerns would be investigated. Staff had provided compassionate care to people at the end of their lives and the provider was developing training to increase confidence in supporting people to plan for the end of their lives.

People told us their staff were kind. We saw staff delivering compassionate and caring support. Staff treated people with respect and ensured their religious beliefs and cultural backgrounds were respected. People were supported to develop their skills and increase their independence.

The provider had taken on board our feedback from the last inspection. However, further improvement was needed to ensure consistency across all the schemes. The systems in place had not always identified the issues we found with the MCA and updates to care plans. The provider was developing their approach to engagement with families and worked closely with other organisations to inform their development. There was a clear plan in place to develop the services that ensured high quality support was central to the process.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 02 January 2018)

At this inspection we found improvements had been made.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.